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1 <br />ELECiRICAL PERMIT :�4PPLICATION. <br />CITY OF EV�RETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 – www.everethva.org <br />AAPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />. <br />i � , , ';i � � ��,.J <br />--. �..- `, <br />i —� <br />Owner <br />Tenarr <br />'r' <br />,,. - <br />! I Eleclrical Confractor <br />1 ��i,� ., <br />Mall Addross <br />h1�il �ddress <br />��. �,. _ 0 .. . � n <br />Add�ess <br />—,,.-.�-n-.p <br />� t�uf �- ��.i a►t� <br />S�ate L�cense NumSer <br />�� <br />Proposed Llsv of euildiny � ��-- <br />Descriplion of Work to Be Done: <br />NOTE: WIRING IN NON-DWELLINGS IS REQUIRED 70 <br />BE IN RACEV�•AYS, MC OR AC CABLE. <br />CITY OF EVERETT LOC,4L SALES TqX CODE IS 3105 <br />Clry <br />��af i3 � <br />Sta�e2iD <br />Phone <br />% City StalelZip Phone <br />/� � �� <br />C4rJ /_•.n.n_a.�_�.., i'n,�.. � <br />City <br />State2lp <br />Phono <br />c� � <br />Cootracl Price of Work <br />_r�� �� �--�� <br />Contact Person (Plan Revlew) <br />certl/y thst I havo read and exern6ied fhis application and know fhe seme to be true and <br />sp/eCired l�ervrnro�r not. nnie q antln� of s pe��rmd doesyno! pres� me t gi e�aufhonty to <br />r cancel the provisions of any other stato or loc�l law rec�ulr,ting construcllon or fhe <br />ince of consPruction. That I arn eu(horized by the ownor ot Ihls p�operty to peAonn the <br />�Wq I� pplicallon !s m�de and I comply ���th (he S(afe Contractors Law i8.27 RCW and <br />PEE <br />F [ CQ� -p�• <br />